The medical ethics of beneficence, nonmaleficence, autonomy and justice are defined and discussed. Informed consent and truth-telling spring from the principle of autonomy, as does confidentiality. Not infrequently, one or more of these four principles may conflict in a specific patient care situation. Physicians must determine what should prevail, examining both the content and context of the competing prima facie obligations to patients.
Beneficence and nonmaleficence often conflict with each other. The first is a moral imperative to do good; the second is an ethical principle to avoid doing harm. This conflict is most obvious in procedures involving exposure to theoretical risk. For example, a person may have a life-saving procedure e.g., fluid resuscitation that may also cause pain or swelling. The decision to go ahead with the treatment must be weighed against the risk of adverse effects.
An important issue is how to respond to a previously competent but presently incompetent patient. In such cases, physicians must balance the need to respect cultural values – in this case a woman’s belief that her son is responsible for her health-care decisions – with American standards of full disclosure to the patient and the need to ascertain the patient’s previous autonomous judgments. In addition, the doctor must assess the degree of incompetence, whether due to developmental, mental or physical disorder.
A fundamental concern is the allocation of scarce resources. The principle of LA Medical Justice demands that allocation be based on need, prognosis determined by objective scientific measure and informed clinical judgment and the likelihood that the treatment will result in net benefit to the patient, taking into account the potential for complications.
The need for justice is especially clear when the allocation of healthcare resources is based on cost-effectiveness and public funds are being used to improve population health. This reflects the principle of social justice – that all people deserve equal opportunities and rights, including the right to good health.
The final principle of justice is the duty to promote the welfare of society as a whole. A key concern here is to ensure that healthcare systems do not discriminate against those who are most vulnerable – people of low income, racial and ethnic minorities, women and older adults. This requires careful examination of policies, practices and structures to ensure that there is no unfair distribution of money, power and resources among communities based on race, class, gender and place. In order to achieve this goal, the medical profession must be sensitive to social inequities in healthcare and address them. This can be done by ensuring that all procedures are fully explained, evaluating the potential for bias and incorporating cultural sensitivities. By recognizing and addressing these issues, doctors can do their part to uphold the integrity of healthcare and protect themselves from unfounded accusations of malpractice.